Tuesday, May 10, 2016

A Critical Review of ABIM's Recent MOC Changes

In its never ending push to preserve the lucrative Maintenance of Certification (MOC) revenue stream, the American Board of Internal Medicine (ABIM) once again announced a "new option" to complete their corrupt MOC program to beginning January, 2018 (corresponding press release here).

The real details of the new option were sketchy and only promised the following:

Take the form of shorter assessments that doctors can choose to take on their personal or office computer—with appropriate identity verification and security (emphasis mine)—more frequently than every 10 years but no more than annually;

Provide feedback on important knowledge gap areas so physicians can better plan their learning to stay current in knowledge and practice and;

Allow physicians who engage in and perform well on these shorter assessments to test out of the current assessment taken every 10 years.

What was not mentioned was the following:

What this "new pathway" will cost and

What "identify verification and security" tactics will be proposed to maintain control of the American Board of Medical Specialties' (ABMS) proprietary MOC program.

Let's break these two unmentioned issues down, since they are increasingly at the crux of the corruption at the ABIM and ABMS.

COST

While I do not know what the "new pathway" will cost, we should note that the changes promised by 2018 only provides another way doctors can provide funds to the ABIM. Their proposed "change" does not remove the requirement for the clinically unproven re-certification MOC metric or its secure examination. Importantly, the new proposal does not address prior fraudulent tax filings or secretive funding of their ABIM Foundation from physician testing fees. What we can be assured, however, is the ABIM is desperate for cash to fund its operations and protect its tests. Given what we now know about the ABIM financial burn rate, it is safe to estimate that the ABIM needs to extract at least $200 per year from each and every internist in the United States (and maybe $300/year from specialists) to maintain their current cash flow.

Look for cost of ABIM's MOC program to be $200-300 per year for physicians irrespective of the various "options" or "pathways" the ABIM constructs to fulfill its MOC re-certification requirement.

TEST SECURITY

This is where things get interesting.

Test security is everything to the ABIM. Without it, anyone could replicate their process or "steal" their copyright-registered health information. Few details of how the ABIM plans to perform "identity verification and security" are forthcoming with their latest press release. But one thing we know, the ABIM will continue to have physicians entrap themselves in contract language promising secrecy and to observe obscure "pledges of honesty" before performing any MOC testing.

How might they protect their tests? Well, let's look at one of the test security options available to ABMS from a little-known test security firm, Kryterion. It seems Kryterion would monitor physicians who opt for the "at home" option using a webcam and microphones. According to Kryterion's Terms of Service, physicians will be asked to scan the room using their webcam before sitting before the computer with a live proctor on the other end of the line:

The Kryterion Certified Online Proctors (KCOPs) are trained to watch and listen for any unusual behaviors from the test taker. For example, unusual eye movements, removing oneself from the field of vision and making atypical noises are all noted and a behavior alert is sent to the test taker, depending on the business rules you set. The test taker is required to acknowledge the alert before continuing with the test and the KCOP resumes or stops the testing process, depending on the action you’d like us to take.

What legal action does the ABIM or Kryterion plan to invoke if they feel my eye movements are questionable? Yet this is the reality of "secure testing" that the ABIM might utilize. And as we've seen, it appears the ABIM is all to happy to deploy their lawyers on physicians at the slightest hint of a "testing irregularity" to extract even more revenue from physicians and to protect their monopoly.

Sorry. but I don't want Big Brother in my house. If this is how the ABIM plans to assure I'm compliant with my continuing medical education just so they can extract more revenue from me under the threat of litigation, they've got another thing coming.

ABIM has still not addressed its financial transgressions, multiple corporate conflicts of interest, high salary structure, and fraudulent tax filings. Unless and until these issues are addressed, look for the practicing physician community to avoid further interaction with the corrupt ABMS MOC program irrespective of any further changes to their MOC program the ABIM might propose.

55 comments:

Anonymous
said...

And others...

!. Cost2. "SECURITY".... "Step away from your open book and put your hands up"3. How many questions per year ? 25...30....400 ?4. if you don't pass THE HOME VERSION ,can you take it over the same week ?5. Why not just use the UPDATE module they already offer ?6. Does this mean the patient voice at al is gone ?7. Why keep the 10 year exam?

How many are still willing to play the stupid victim? How many are willing to let the ABIM/ABMS continue to be the harbingers of the demise of medicine and destruction of civil liberties?

You are right, Wes, about the burn rate/ABIM costs and the dire future we face under the control of greedy professional medical bureaucrats like Baron and Nora!

And you are absolutely right on about your prediction of "Big Brother and the Testing Security Company." Read the quote from the Kryterion website below:

Kryterion ("Big Brother") proctored testing website advertisement - "As the healthcare industry evolves and becomes ever more specialized, everyone from government entities to the general public are demanding accountability of healthcare professionals. More and more healthcare boards of certification are turning to Kryterion to help them manage their certification programs and ensure that practitioners have the skills and required knowledge to practice in their chosen field."http://www.kryteriononline.com/Markets/Healthcare

Does the wording sound familiar? It should, Kryterion and their parent company/partner Caveon (online test security/copyright enforcement spies) have had an ongoing, albeit egregiously conflicted, relationship with the ABIM/ABMS et al, through key shared security testing personnel. These are verifiable facts from at least 2007 on, and these facts are even more onerous and true today.

It gets interesting the more you look for corrupt connections/financial relationships. This has implications for ABIM v ABR. Or the current persecution in ABIM v Dr. Salas Rushford. The DOJ or especially any interested suing parties(that means any informed physicians)harmed by the ABIM/ABMS or any of their testing security employees/contractors might be very keen to explore these dark aspects of these monopolies and the cronies/corporations they represent. The list of harmed stakeholders would be nearly every physician and institution who pays to play in this involuntary and therefore illegal certification/testing/security game.

At this point in time physicians and patients should have awakened sufficiently to the fact that the only relationship they should have with the ABIM/ABMS is adversarial. It is time for the ABIM/ABMS to start paying. Anything other than an adversarial relationship with these corrupt organizations and their "profligate officers" is sick and twisted. It is protracted pain. It is financial usury.

I ask again. How many are still willing to play the stupid victim, Wes?

Wes, for further study look at the leadership connections at Kryterion/Caveon/ABMS/McGraw/Prometrics/Pearson etc, and see how deep the testing industry pockets are and how severe/all encompassing the control goes. This corruption is decades in the making to get to the point of this much control. The certification industry and the legal entrapments get more and more onerous to the point of total ruination of lives and medicine. No more onerous/legally binding copyrighted certification tests! Participation in MOC is like saying yes to one's own assassination as an individual!

Not one more penny or minute of time for these mesmerizing vampires. I've had it with the continuous stream of disingenuous lies from these money-grubbing executive medical fraudsters. They ask us to willingly keep our neck in a pretty noose while they steal our time and money. God damn the ABIM and their dark evil secrets! They can go to hell and stay there. Look at all the court documents written by Satan's dark-mouthed lovers. They truly are the walking dead. Let them bury each other!Get a silver spike and drive it through the ABMS heart. If you have yet to be bitten stay away!

Anti-MOC legislation: Anything less than what we have seen in Oklahoma is a partial victory only. Each state must organize a concerned socially responsible body of physicians/legislators to pass a complete anti-MOC legislation or keep trying.

MOC: ABMS/ABIM should (using physicians' fees) to reverse lobby legislature, hospitals, insurers in order to end all mandatory MOC linked to licensure, employment or reimbursement. Anything less than total freedom to choose CME that is relevant and useful (as is necessary for state licensure only) falls short of what is reasonable, relevant and useful. ABMS has skirted the ethical and lawful violations consistent with the operation of an honest responsive testing company.They have no desire to be a non-profit service - only self-seeking financial gains and continued self-appointment of cronies to stay in power politically. They are a broken mess - an absolute joke devoid of medical science. The government needs to close them down forever and penalize the executives ordering them to pay back funds stolen and do socially responsible work / or serve time teaching 'healthcare management' in minimum security institutions.

Concerning this 2018 nonsense: Some physicians think that a relationship with ABIM or any ABMS medical board is inevitable to maintain knowledge skills. It is not. In fact the opposite is true. They do harm.The ABIM for example has had only arrogant self-centered aims and not certification or recertification/public health in mind at all. They have never produced a reliable annual test. Figure that. How little they spend of the tens of millions. What public servants they are!

They have never made testing materials available as they should based on the actual science and tests. They should have also made past tests and questions available. What about the money. The RWJF (affiliate of Chris Cassel/Rich Baron)could have paid for it all as a real service to humanity - not the sham political and pseudo- socio/politico/science they fund. The copyright of science is a problem. Not only is it questionable it is unethical and has led to an obfuscation and corruption of medical science at the ABMS.

In case one does not get it. Money is the root of this evil and the politically ambitious executives in charge of these "voluntary" "educational" "boards." They have steadily become regulatory bodies controlling physicians for political and economic reasons. That is the bulk of it. They get their libidos off on politics apparently - and owning expensive properties with chauffeurs/dating escorts.

The doors of the 24 medical boards should be closed down with CME and certification left to competent focused educational institutions -- not political ones led by the likes of Lois Nora, Christine Cassel or Richard Baron. Isn't this clear by now. Lobbying to cheat physicians and push a national healthcare agenda and a Choosing Wisely corporate/government-backed austerity has no place in a "quality assurance" organization. Fraud and corruption. Don't you see it. Stop pretending that these oligarchs, emperors, and czarinas are wearing any clothes. They have no modesty or shame.

As stated in my Feb 12 2015 letter to Dr Baron ABIM, "1. Thou shalt not steal. 2. Thou shalt not bear false witness against thy neighbor." That includes all ABMS executives attacking fellow Board diplomats with four parts of burdensome, irrelevant improvement activities with increasing time and fund commitments to their testing organizations. Dante, hear us. Is there a special place in your Inferno reserved for the ABMS and all its 24 umbrella specialty Boards, including ABIM, who accept the corrupt practices listed in the 13 page document "Standards for the ABMS Program for MOC" For Implementation in January 2015? Four parts of burdensome crosses are being thrust on good physicians and scholars. Already Boarded diplomates are being slaughtered like lambs. Questions? See Vice President for Marketing and Communications ABMS Richard Waters for details, as stated in the end of the document (Jan 14 2014). See also Larry Israelite's book, LIES ABOUT LEARNING, 2008, w more information on this $109 billion commercial self-improvement industry.

In their announcement, the ABIM also states that they will be implementing a "new more frequent shorter assessment" methodology in 2018. They go on to further state that those that are slated to take the secure exam in 2016 or 2017 will still be required to pass the current secure form of the exam in order to remain certified. Their survey found that 80% of those surveyed did not want an onerous secure exam. So why are they perpetuating this miserable exam? When the ABA announced that they were doing away with their secure exam, they made it effective immediately. They introduced the MOCA Minute which any anesthesiologist could complete on their smartphone when they have a minute.

Rather than allow those that have to recertify in 2016 or 2017 to skip the exam and wait till a new hopefully relevant MOC is introduced, they have made it mandatory for these physicians to take the current secure exam despite their survey findings. Why? They claim it's due to their obligations to the entities that utilize their certification. The reality is that they don't want to lose that revenue stream, both from the test itself and from those that fail the test. Most physicians will likely opt for the new shorter frequent assessments. However, as ABIM has clearly stated in their notice, we must do well on these assessments to place out of the longer secure exam. Essentially, we will have to pay for the technology associated with this new assessment methodology. For those that don't do well, they will likely have to pay more money to take the secure exam.An additional interesting fact: Physician champions of MOC actually don't participate themselves by taking the secure exam!

Most of the executives at ABIM including the CEO (Dr. Baron), CMO (Dr. Battaglia), VP of Research (Dr. Lynn) have certified prior to 1990 and thus have certificates which do not expire. This means that they do not and probably have not taken the secure exam since their initial certification back in the 80s.

Take a look at their Board of Directors. Most of them were 'grandfathered' in and most likely have not taken the secure exam for recertification.

Additionally, Dr. Christine Cassel who was their President and CEO from 2003 - 2013 is NOT participating in maintenance of certification! According to the ABIM website, MOC is supposed to equate to lifelong learning. Since the former 10 yr CEO of ABIM is not participating in MOC, does this mean that she is exempt from this lifelong learning? Or is it because there are no repercussions for her as she is grandfathered in by being permanently certified?

The ABIM MOC in its current format is a sham! As it stands, those grandfathered as a result of certifications obtained prior to 1990 and those with recerts due in 2018 will participate in the new MOC with the frequent assessments, possibly open book. However, those unlucky 12-15k physicians who happen to need recertification in 2016 or 2017 are being left out and are being told that they have to take the secure exam. Seems unfair to me!

In summary, the ABIM needs to do the following:

1. Design and implement a new clinically relevant MOC asap and not in 2018! This design should be based on their physicians input. It should be introduced this year and not in 2018. They certainly have enough cash flow to accomplish this in an expedited fashion.

2. Since a new MOC is coming, they need to include everybody and let those that have certifications expiring in 2016 or 2017 the option of not taking the current secure exam to maintain their certification! Keep their certifications active and grandfather them in to the new MOC once #1 is completed.

At this point my on Earth should any reasonable person trust anything that the ABIM/ABMS/Baron/Nora/et al have to say? Put a bullet in the head of MOC and be done with this nonsense once and for all! STAT!

Physicians must ask what kind of personal and professional life they wish to have. ABMS and its flagship medical board ABIM are not trustworthy partners. The ABMS has deep pockets because of physicians. But not a deep question pool or educational materials that anyone can get behind truly. Think about it. The affiliations and money schemes get more and more twisted and unbelievable. Now they want to bring their versions of "big brother/surveillance" into our homes and offices and hold us accountable for criminal as well as civil prosecution. No thank you!

Is Kryterion/Caveon a new ABMS/ABIM partner or a well established one? Who are they?

Kryterion/Caveon is the result of a two-pronged capital venture enterprise of David Foster Inventor/CEO and other former heavyweights in the testing/publishing/security industry. We must understand their unique place in the testing security/publishing industry. Kryterion is an online proctored testing company partnered with the testing security company Caveon. Caveon employees work out of their homes in Utah and Kryterion has offices and main body of employees in Arizona.

Caveon's notoriety

Caveon's testing forensic security "spies" were responsible for putting teachers in prison/fired and closing schools down in Atlanta and other major cities. Teachers were sentenced to hard time in prison. Because they professed their innocence even at sentencing the judge gave stiffer sentences where no jail time should have been meted out at all according to most people. It was absurd, but such is the power of the publishing/security lobby and the big money they were protecting. Regarding the Atlanta teachers Rev. Bernice King, daughter of the Rev. Martin Luther King Jr., said they were “victims of a corrupt education system...”

These testing spies are highly motivated to find testing "cheaters" and that is how they make their money and lots of it - soliciting organizations, state and government contracts. Caveon uses a secret proprietary forensic logarithm utilizing the principle of identifying simple testing anomalies to catch cheaters and often help to vigorously prosecute them. In the case of Kryterion online proctored testing, if ABMS uses a program like that, Caveon will have the house stacked against you, because the more instances of cheating they catch the more they get paid.

One major party involved in a city/state contract accused Caveon of cheating themselves in downplaying cheating because of their main client's concern for the negative outcome.

Sounds like possible conflicts of interest? Well it is. It's all about money. Ballard Spahr - ABIM's legal team - will of course be frothing at the mouth when online proctored testing with their "proprietary pledges" are put in front of physicians to digitally "sign" without any choice or written copy in advance to purview. This sick violently aggressive testing security industry must be stopped from harming the medical profession. It has no place in medicine.

Caveon/Kryterion were both conceived/started together around 2001 - the same time our government passed the legislation for "no child left behind." This educational law, which the testing/security industry lobbied for (sound familiar) put a great deal of psychological pressure and stress on children and teachers. This along with more onerous copyright laws helped Caveon/Kryterion gain market share and became a virtual monopoly in the industry through its present and past insider connections.

Caveon's early financial foothold and profit accelerated around 2009, but Kryterion on the other hand was struggling with massive debt - this was same year that Arora/ABR was violated and prosecuted by Langdon/Baron and the ABIM's lawyers. Tightening/stricter enforcement of copyright laws, especially unsigned take-it-or- leave-it pledges/contracts hurt physicians and teachers alike. These pledges with the onerous policies were developed by these and other executives in the testing/security industry to grow revenues and increase the bottom line for the big publishers and to create a stranglehold on clients and the lucrative markets. Their secretive security/surveillance/legal teams had a hand in the development of the ABMS' security/copyright policies/pledge.

The debt-ridden Kryterion may have forced some issues with David Foster's other company Caveon pressuring them to push for money from clients and investors. One wonders looking at the real harm they have done to people and education through court and the media action whether financial motivations could cloud reason and conscience in their part in persecuting teachers and physicians.

ABIM and Caveon/Kryterion

I will say this much for physicians to consider and verify, Caveon/Kryterion associates/personnel were utilized in the persecution of phycians/board review companies starting from 2007-2008. These employees/contractors from the ABIM testing security division/Ballard Spahr legal working closely with Langdon, Baron, Cassel and Holmboe were highly motivated by money, position and political opportunism. It would be completely fair to say that these groups of people committed egregious acts against human beings that I consider unconscionable and when we look at the whole business and history highly illegal.

In an opinion piece in the NY Times Bob Wachter touched on some of issues facing teachers and physicians in an aggressive quality assurance marketplace.However the pure monetary motivations were not discussed but he should have. The article should have voiced opposition/concern about the egregious conflicts of interest in the quality assurance industry and the "corrupt enforcement" of what for physicians and others is claimed to be voluntary, yet it is not. The testing/security/certification industry is totally devoid of love!

What's also alarming is that the big publishers/test companies share board members/sell assets to each other, share employees without much regulation/monitoring and have secret deals worked out often in carefully constructed step processes to the detriment of clients - not with "educational measure" in mind but for an extra measure of profit.

What is also deeply troubling is that some of these testing companies like the ABMS and ETS enjoy a non-profit status. Executives receive huge compensation packages. Taxpayers bear the brunt for this kind of abuse to testing clients - which often are the taxpayers themselves. Clients pay through the nose for testing and certification in a circular scam and double payment/tax burden.

The Kryterion CEO imo is a product of an unethical corrupt industry that needs to be reigned in. In a recent lawsuit against Kryterion one of the platform developers complained that the patented technology is not secure! What's more the company was in such deep debt they were lying to investors about the readiness and reliability of the product/service they were pushing on them. Much of this court document and settlement like the ABIM v ABR settlement is held only by the adversarial parties. The court document accused Kryterion executives of committing fraud. I cannot address that but they paid to bury the accusations and monetary problems.

I believe physicians should take an interest at what the ABIM and entire ABMS umbrella of medical boards is doing behind their back and how relevant/secure it all is. I would protest/sue the ABMS for violation of phycians' hard earned money with alleged fraudulent products/partnerships, violations of civil liberties and repeated assault on privacy that the ABMS and ABIM inflicts. They do this with an increasing array of unvetted contractors and their highly conflicted employees/executives.

This is an injurious relationship all the way around. Physicians are battered and they do no know that they need to have a lawyer to get out of this relationship as quickly as possible. It is wrong thinking to try to get the other party to change. It is not possible, unfortunately. ABMS pockets are sullied with the 'blood and filth' of corruption. Physicians are acting like beaten mob molls - too afraid to do anything - not knowing how to get out. The 'authorities' have awareness of the 'crimes', but do not care or are bought out. Primarily the Fed/State/City does nothing to help because they think it is a moll's fault for allowing the bad relationship in the first place. It was their own volition and choice they say. It is by their own choice that they stay.You think you are not just a mob moll? Look at it this way. Does anyone really have good thoughts about this narcissistic organization or the pathetic relationship. Does anyone love 'Rich (sorry-we-done you-wrong) Baron'? 'Chris (castle on the hill) Cassel' lobbying against physicians and patients for her corporate/political cronies?Try to find a lawyer and a judge you can trust that is working for you and not them. Get the state to change the laws to protect battered physicians. Go to the hill and get the Attorney General to make it a national priority to protect your civil and professional rights.

Who corrupted the original articles/mission of the ABIM and the other 23 specialty boards and why? Who put everything under the command of the ABMS "high commission?" Who advised/wanted this?Did it all go down on the Hill around the time 'Thomas (Big Tobacco/Wall Street) Brem' and his big ink pen (1965) turned the ABIM and ABMS into 'quasi-regulatory bodies' working for the corporation, government, and military industrial complex?The Father of the ABIM was dead (1961). Jack Kennedy was taken out by a lone assassin (1963). Vietnam 'war' was ramping up. Surgeon General claimed tobacco is bad for your health (1964). Stop smoking America. Medicare law (Social Security Act 1965) was just passed by a wide margin in both houses. King was slain by a racist(1968). Bobby Kennedy in his moonshot for the white house was shot in the head by a crazed gunman (1968). He would have been on his way to get union/labor support Chicago after CA. Thomas Brem, MD (ABIM, ABMS) said cancer sticks were not that bad for you (1969). More study needed. Men landed on the moon ahead of schedule.

Good new: Civil rights laws of 1964 may now apply to physicians who are becoming a trammeled/shit upon minority being pushed to the back of the bus. Good luck.

Patients and Professionals are Left in Medical/Financial Limbo. A Strong legal challenge/complaint is needed. A plea for real relief not lies and financial/political abuse.

Wes, I believe strongly that we need to investigate the ABIM - thoroughly - as you have been trying to do/initiate for quite some time. Kurt Eichenwald called for an investigation by several of our federal agencies including the DOJ and IRS. We all need to understand the situation we are in - whether patient of physician. This abnormal dependency on MOC and the state of being in a medical limbo and financial hell has been thrust upon us by the ABIM/ABMS along with their associates/collaborators.

There is/has been no transparency of their business plans or models. I suspect form what I and so many others have uncovered the truth is that the ABIM and other boards were planning/conspiring to end the 10-year certification with its troubling accounting for quite some time - or at least as a contingency plan. Judging by the ABIM/ABMS chronology/timeline of business/investigative/legal relationships (established and sustained for the past several years) it may have been THEIR PLAN all along to end the 10-year (all day) test to save considerable money on test preparation and to go to a modual/online proctored test model with the annual participation requirement to boost revenue streams and enhance lucrative business relationships.

Most physicians who still pay to play are now paying annually anyway. To make physicians pay for this year's 10-year or next year is not only inappropriate, but possibly violates of consumer/fair business laws.

By adopting an annual revenue stream as they have clearly have done a couple fee-payment cycles ago the ABMS/ABIM already forced physicians/institutions to pay 200-400 or more every year to be "certified"/"participating in MOC." This was unprofessional, ethically wrong, with the appearance of negligent and reckless behavior.

The ABIM under the wing of the ABMS' protection have done grave wrong over the years to physicians and the patients they serve. The ABMS/ABIM imo have violated many of our complex business/professional ethics/non-profit tax law and commonly accepted standards. There is ample evidence that they have for years been cheating in many and several similar ways harming clients and the patients they profess and claim boldly to serve and protect.

Before any physician, society, or patient population accepts any proposals from the ABIM or any of the ABMS boards, there needs to be a very broad legal probe/action brought against the ABIM/ABMS in order to investigate/fact find the hidden business practices, models, including any/all conflicts of interest or inappropriate political/lobbying activities while under contract. All these things need investigation in order to clarify any possible wrongdoing of the ABIM/ABMS before physicians jump on board this very tainted certification/recertification bandwagon.The bandwagon has certainly rolled ahead and gotten away from every member board and especially the ABIM.

The stakes are just too high to do otherwise. The ABIM in Philadelphia and ABMS in Chicago need a strong legal challenge on their business practices and non-for-profit status. Any transparent organization would willingly open their doors and books inviting the DOJ and IRS to examine their operations. They do not invite a probe and they resist discovery because there are legal/business bombshells they are obviously hiding - sitting on a very old time bombs that would have disqualified them from IRS exempt status now and decades ago.

Financial and Political Time Bombs at the ABIM and ABMS? Should ABMS/ABIM Executive Release Their Personal Income Taxes?

We could make a good argument for the release of personal taxes as part of a probe and as a continued practice to help gain trust.

As public servants/state actors in very important regulatory/quality assurance/advisory positions it should be, imo, incumbent on all officers of the ABMS member boards to release their personal tax documents as well. How can we trust them otherwise. The alleged and actual offenses of these executives and the entire gamut of member boards if put on a graph would be almost straight up after the first president and CEO's were self-appointed.

We are referring to the era of independent executives - with self-initiating actions independent of the boards. This started in the 1960's, the decade of transition, culminating with the executive appointments beginning with the first president in 1975. This led to compromised puppet governance dominated by the highest bidder as in the case of Thomas Brem and the first president Dr. Benson who apparently appreciated the boost in pay and easy corporate executive lifestyle. The organizations no longer served medicine but corporate and political interests from that point on. A thorough investigation of all the ABIM records, even if for historical perspective and not a criminal investigation will clearly show the compromising positing that patients and physicians were placed in after this transition to the corporate/political model.

I submit that the ABIM has been used as a political tool for corporations and crony political partisanship with definite and clear political agendas. If the ABMS/ABIM was used as a springboard for money and partisan politics as any junior high civics student would easily recognize, why has nothing been said or done about it. Non-Governmental-Organizations and network of affiliates like the ABIM/ABMS have and operate in collusion with need to be investigated. The conflicts of interest which abound and obvious financial wrongdoing, the power abuses and many other problematic concerns voiced by physicians and patients have need to be addressed and rectified - if it is so determined by federal/state/local authorities or the courts in investigative/legal challenges and financial complaints.

We cannot have it any other way in a fair and free society. We need a thorough investigation. As it is the ABIM and ABMS medical boards have become secret societies and executives appear far too often in the 'lobbying halls' and in 'testimonial halls' on Capitol Hill.

Transparency as a model demands such an action and the release of personal tax records, as well. This should be proposed as a quality assurance measure to the public the ABIM/ABMS serves. Surveys confirm that the public no longer trusts their officials and big corporations. Clients of the ABMS do not trust the member boards executive officers. Patients/voters, if they knew, would give a vote of no confidence in the ABMS officers, with a particular emphasis of distrust expressed toward the largest organization - the ABIM.

TTIP: Fast-Tracking Corporate Medicine the Executive Way (What's in it for the ABMS and what are the implications for the future of MOC? Nobody's saying anything or asking! Why?)

Looking at the new "Free Trade Agreement" with the EU. What does it mean for corporations involved in healthcare? What's in the deal for 'Big Tobacco', Healthcare monopolies, agribusiness, and the big food companies. What's in it for the ABMS cartel? MOC continuation as a non-negotiable item? Why does it seem to be written (in the leaked documents) that corporations will have sway over consumers/citizens/governments.

Why is nothing said about the secret arbitration courts that will always "settle" disputes in favor of the wealthy banks and corporate sponsors of TTIPS. Why is the content of TTIP kept secret? Why does Christine Cassel and her corporate cronies want this to pass so badly without seeing it or having any discussion?

1) Why is the current system of CME suddenly insufficient? Is ABIM MOC necessary and who has good, objective data, without COI's to prove it?2) Where is the proof that the presence of MOC (in addition to CME) is improving public health measures? If there are none, then why are the calls for MOC so over exaggerated?3) Why can't the ABIM eliminate monetary waste? They are freezing the cost but we all know they are pricing in luxurious amenities for themselves. When will they drop the price and be economically honest?4) When will the ABIM and the ABIMF be regulated by the Federal government? The ABIM MOC has been shown in the literature to be a MASSIVE WASTE OF TIME AND MONEY. If CMS and DOJ are making fraud, waste and abuse/overuse a target for oversight, shouldn't they look at the ABIM and the ABIMF as well?5) Why is our leadership so poor and fragmented that individual State's are legislating their liberty to neutralize the burden of the ABIM?6) How much money did Zeke Emanuel receive from the ABIM and the ABIMF as a "consultant" or "advisor"?7) What is the % of academic vs clinical physicians who are ABIM Diplomates? Does the current leadership structure accurately reflect that %? If not, why?

So let me get this straight. The new ABIM MOC paradigm is to take the same test at home but activate my webcam so some stranger can spy on me? Oh and I get to pay the ABIM more money for this "privilege"?

Are you ABIM folks insane? That's such a bad idea and a pathetic attempt to hold on to the old version of ABIM MOC.

The ABIM just relishes in portraying clinicians as a group of underperforming dolts who are in desperate need for "recertification" or whatever insulting term they use to denigrate the Diplomates. Why? Then their precious trademarked questions are monetized and turned into an annuity for their spreadsheets. What does that allow them to do? They can now borrow money against the theoretical stream of guaranteed income and clone themselves into more regulatory versions of themselves.

So here is a new thought.

I WILL GLADLY TAKE ANY VERSION OF ABIM MOC IF

1) The Federal Government, the State Governments and the DOJ publicly audit the ABIM and the ABIMF.2) The cost of any version of MOC- ABIM or not is fully shouldered by the American Taxpayer and open to Congressional oversight.. 3) The cost of preparing for MOC (prep courses, CME, DVDs etc) is fully shouldered by the American Taxpayer.4) The concept of MOC is utterly and totally non profit. Net zero dollars every year. No money laundering. No sneaky transfer of money from the ABIM to the ABMS to the ACC to the ACG to the ACS to the ACGME to USMLE or whatever.5) The leaders of the MOC or ABIM are in non-paid, purely voluntary positions. No extra money to be Dr. Rich Baron CEO of the ABIM. No slush fund for Mr Cassel to ride First Class on US Airways to Chicago or Seattle. No plush shuttling in a limo across town to the Four Seasons.

How much you want to bet that if the ABIM CEO position was now voluntary or severely or severely defunded that Rich Baron would lose his "passion" for this job?

Looking at the pictures of their condo in Philadelphia, the chauffeured Mercedes, their finances....unbelievable! Is this what all of my fees have paid for? I worked my butt off to fund their lavish headquarters and so-called investment portfolio?

Also, they still haven't released their financial statements. What are they hiding?

Did they really think they could calm the storm by making an announcement about new testing options starting in 2018? The announcement itself is crap because it requires one to do well on these new assessments in order to avoid having to take a closed book secure exam. This clearly indicates that they are out of touch with reality! Almost every doctor that I know of utilizes some sort of reference material to look up information at the point of care. And when their limit is reached, they call in a consult. Given the advance of computers, decision support tools, references materials, why are they insisting on sticking with antiquated methodologies of treating patients? We as physicians need to evolve and leverage available technology in treating patients. ABIM's MOC program should reflect this by getting rid of the secure exam for recerts all together! And why would they insist on having those due for recertifications in 2016 or 2017 take this burdensome exam? They clearly made the wrong move by not suspending their secure exam effective immediately for those that need to recertify!

Let's talk about their former leader who championed MOC, Dr. Christine Cassel...she is not even participating in the program! Take a look at Dr. Christine Cassel's ABIM certification. She was 'grandfathered' into Internal Medicine but has dropped her Geriatric Medicine board certification. However, if you look at her Wikipedia Page which was probably drafted by her, it states:

"Christine K. Cassel, MD, President and CEO of the National Quality Forum, is a leading expert in geriatric medicine, medical ethics and quality of care. Previously, Dr. Cassel served as President and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation."

"Dr. Cassel, board certified in internal medicine and geriatric medicine, is a former Chair of the ABIM Board of Directors, and is a former President of the American College of Physicians. Recipient of numerous international awards and honorary degrees, Dr. Cassel is an Honorary Fellow of the Royal Colleges of Medicine of the U.K. and Canada, the European Federation of Internal Medicine, and is a Master of the American College of Physicians."

And yet, this woman was the President and CEO of the National Quality Forum? What a hypocrite! The ABMS Program for MOC states that "...it serves the patients, families, and communities of the US (the Public) and improves patient care by establishing high standards for ongoing learning, practice improvement, and assessment activities of diplomates....." Apparently, as soon as she left ABIM, she was exempt!

More recently, the ABIM has being making rounds at the various society meetings - ACP, SHM, SGIM, ATS etc. They are attempting to obtain feedback about their MOC program. Guess who is paying for the airfare, lodging and food? It's us! There is enough feedback from the various blogs and articles but maybe this is not enough for them. Of course, by making the rounds, they will be able to say that they listened to us and based on the feedback received, they are on the correct path. Who's going to validate that statement when they make it and challenge them?

ABIM - if you are reading this, listen to your diplomates. You have enough feedback. Suspend the secure exam for recerts immediately. Do not force those recertifying in 2016 or 2017 to take the secure exam. Come up with a new MOC with new assessment options that makes sense for everybody. If you build it right, the physicians will voluntarily start participating in MOC again. After all, MOC is supposed to be voluntary, isn't it?

Christine Cassel , prior CEO of ABIM, not participating in MOCThomas Nasca, current head of ACGME, not participating in MOCKevin Weiss, prior head of ABMS, not participating in MOCJeffrey Drazen, editor of New England Journal of Medicine, not participating in MOCWendy Levinson, prior board chair of ABIM, not participating in MOCTalmadge King, prior sec-treas of ABIM, not participating in MOCF. Daniel Duffy, prior executive VP of ABIM, not participating in MOC

To anonymous "let's get this straight:" There is clear evidence of ABMS' relationship with CAVEON/KRYTERION and CEO David Foster. You can "Google" 'ABIM Caveon' etc., and 'ABMS Kryterion' and see what pops up. I copy pasted below for you. Warning Caveon uses a surveillance program that reads you IP address and may track your activity. Use a library computer or Tor search engine to study their website, but plenty is found out about them outside their site.

To prove/show that the ABMS has been working with online proctored testing read the ABIM's 20/20 taskforce. On page 9 ABIM expressed "how fortuitous" it is for the critics of 10-year MOC that ABMS/ABIM already had the annual assessment plan in mind with online proctored testing. $$$http://transforming.abim.org/wp-content/uploads/2016/04/assessment-2020-final-report.pdf

Further proof of Kryterion/Caveon relationship we can see David Foster CEO of Caveon and Chief Inventor at his other 'brother' company Kryterion was paid to speak at the ABMS meetings. The intention of using online 'big brother' proctored testing (with guaranteed third-party Caveon spying) is real and the ABMS has employed/paid other Caveon/Kryterion/ABIM/Ballard Spahr key executives and employees - currently and in the past. For example: David Foster https://abpedsfoundation.org/blog/speaker/david-foster/

BiographyDr. David Foster currently serves as the CEO and President of Caveon Test Security. He is also Chief Scientist at Kryterion. He started another successful company, Galton Technologies in 1997. He directed the certification test development efforts at Novell from 1990 to 1997, introducing many new innovations, including adaptive testing, testing in multiple languages, and simulations-based testing. Dr. Foster has participated, on several industry boards and councils. He has been President and Chairman of the Association of Test Publishers, served on the Board of Directors for the American National Standards Institute. He also founded the Performance Testing Council to further the use of tests that directly measure important job or educational skills. He has authored numerous articles for industry trade journals, scientific journals and textbooks, and has presented extensively at industry conferences. A recent publication in Psychology Science Quarterly introduced a revolutionary variation on the multiple-choice question format and conducted research supporting its use. He has been creating and improving computerized testing systems since 1982 and has been influential over the past 33 years in introducing many important industry innovations and initiatives. He has helped create new security technologies that use the Internet to administer high-stakes tests in schools, the workplace and even the home. Dr. Foster graduated from Brigham Young University in 1977 with a Ph.D. in Experimental Psychology and completed a Biopsychology post-doctoral fellowship at Florida State University in 1982.

It's all about the money and control of physicians. Refuse to digitally sign anyone's pledge and you are not vulnerable to criminal or civil lawsuit.Like voluntary certification and MOC there is a 'catch 22'. Phycians and patients are vulnerable until legislation is passed in every state.

I would add to Oklahoma-type anti-MOC legislation the declaration that ABIM and ABMS are criminal politically ambitious organization with a known history of racketeering and continually conspiring to harm physicians and patients in order to place all the boards of the ABMS on a watch list.

OR better yet ban the member boards from operation in each state. What the ABMS and the ABIM have done to patients and physicians in terms of corporate fraud and financial manipulation and cover up is horrific. Add the choosing wisely campaign designed to undercut healthcare for vulnerable populations and it is more heinous than any Mafioso organization could ever think up in cumulative effect and sophistication.

My sister is a doc and a good one who has a severe case of grief with the whole MOC thing. Here's my input for the fake-docs in Philly.

I agree with "Basic Questions." Take the darn money away from them (you) and make it all no cost to physicians. Have universities include a certification at the end of residency and fellowship and make it for life as intended. As a patient I'd rather see the certification administered by residencies. It's called a graduation certificate - with pertinent signatures. Certification is meaningless and full of conflicts of interest. That disturbs me. I see it. Why does the state attorney not see it. How can anyone even trust that cert. or the Moc hype?

That residency graduation should be enough in this day and age. Funny, but I have not encountered any snake charmers on the street with herbal tincture of alcohol lately. Have you? I never saw a lawyer with a recertification requirement getting nervous or going into a rage at the thought of it like docs do. Funny how that is. Ha! Are you all pussies in the sense of being intimidated by all those corporate blow heads in Philadelphia? Families sue each other over a toaster in a will. What's wrong with litigation. Use it and use it a lot and you will be done with these mobsters and liars.

Does certification matter to anyone? Maybe 100 years ago it might. I understand from reading that the big reason the docs of the past were less successful in their outcomes than contemporary ones has to do more with antibiotics and other scientific advancements - certainly not a multi-million dollar scam politician pushing $2000 dollar paper like the former CEO Christine K. Cassel. Or the present big sporty guy with the expensive portable jaw - Richard Baron.

How many docs got Cassel on their certs? Quite a lot, I imagine to have earned all those bonuses and walking change of nearly 2 million! I'd maybe (just maybe) sell my friends for that much money. That's what money does. Get rid of the temptation to transgress. I'd feel awful if I did so much bad to my fellow physicians. Really! After 'initial certification', who would force-walk an extra mile out of their "friend" or colleague just to punish them with MOC and then make them pay through the nose for it every year. How bizarre! Anybody could put two and two together and understand this was all a financial Powerball scam.

How long was that Cassel "rhymes with witch" there syphoning the Foundation gas tank for her own Mercedes. What a retirement package she got after what? 14-20 years of meddling and political manipulations. I saw her at an AARP thing on C-Span and she was sickening to watch and how she lied saying this and that that never came true - only selling commercials something for the insurance companies.

Funny thing she's not even a real democrat. That's for sure. She's just a corporate/Wall Street sellout, rhymes with a "real political bore". Maybe that's the new wonky like her friends in high places. I never heard of these 'deep state' types like Cassel until I started studying why I am so underinsured right now and paying more for it. Why I'm always on the phone with the insurance company. Or my FSA auditors. I'll track the people down whoever was the cause or mouthpiece for the insurance companies that did this to us all.

These guys and the other politicians - along with that weird tower of 'transgressions' - in Chicago are nothing more than political snake charmers anyway. They really scammed more people than Bernie Made-off with your money. I am really interested in that "volunteering" they do during normal business hours visiting both houses of congress (and their private offices) while on the ABMS time clock.

What a scam. I'd love to see a patient centric investigation or documentary on this subject. It's fascinating. This one's for you big Sis!

My only question to you, Dr. Wes Fisher is, are these "transgression" you mention in your critical writing or are they something more actionable in a court of law. I'm pissed off about what they do to my Sis and I need someone to blame for my bad insurance - my premium is going up 32% next year.

This is certainly no ordinary testing company, you can be sure of that. It is a steam roller pulling the political and financial strings. Sue em for taking part in defrauding the public for us about the unaffordable state of healthcare.

Hey, "Looking at the pictures of their multipurpose playhouse condo in Philadelphia".

Has anyone actually understood why they needed the condo - who it was purchased for - and what type of business activities and other entertainments and horsing around went on there at physicians' expense? What is it called Castle's Condo - "Dickey's Dacha?" Bob Wachter pulled the purse strings open and approved it.

If you are interested the accumulative extracurricular expenses for that luxury and entertainment is all properly listed on the their annual 990 tax forms. But, unfortunately, it is all listed under "OTHER." However, don't give up, if you are dying to know and have persistence and clever tact you can always call one of the many escort services locally there and talk to some of the "friends for hire" or just ask any of the former or present chauffeurs about the comings and goings.

The ABIM ought to know one important thing about human psychology.

For money anyone will sell you out - even the chauffeur, cleaning staff, or property management. Even the real estate agents love to talk it up about the entertainment potential.

But of course the rich ABMS execs understand the meaning of selling out.Of course they know you can always count on getting rich if you have power. As Newt said, "You can't trust anyone with power."ABIM thrives on money and power. Take the money away and they have no power and no ability to acquire any. Then it is out on the street the way they spend.

On Wed., May 18, the Senate Consumer Protection and Professional Licensure Committee will vote on SB 717, legislation that allows CRNPs in Pennsylvania to practice independently and eliminates the requirement that they collaborate with physicians. In effect, this legislation would give CRNPs equal clinical authority to primary care physicians. It grants them full independent practice authority several years before a physician can obtain the same and with thousands of hours less training.

Some may ask - how is this happening? Well, while we were all busy worrying about CME, MOC, MOL and studying / taking the recertification exam while taking care of patients, the CRNPs were busy with continuing education, patient care, forming a strong PAC and lobbying legislators for more authority while at the same time improving their patient satisfaction scores.

What about those that don't have to do MOC because they are grandfathered in? IE: Leaders of ABIM. They are too busy making a name for themselves and increasing their fortunes while ignoring their fellow physicians. After all, it's every man for himself.

On a different note, CRNPs don't have the same Continuing Education Requirements as Physicians yet they will likely be given the same authority as physicians...if not this time around, definitely in the near future. To recertify every 5 years, they must demonstrate that they completed a certain number of hours of continuing education and must have 1000 clinical hours. They only have to retake an exam if they don't achieve the above or let their certification lapse.

A part of me says that we shouldn't be blaming anybody but ourselves. There are only a select few fighting the current version of MOC (ie: Dr. Wes). The rest of us just say - "It's the cost of doing business", shrug our shoulders, take the exam, pat ourselves on the back when we pass and say "Don't have to worry about that for another 10 yrs....whew." Even now when I mention to colleagues that those recertifying in 2016-2017 have to study and take a secure exam, I get a response, "Glad I don't have to do it! I just lucked out!" Again, every man for himself.

Remember, we let the ABIM and the ABMS rise to this level of power. They didn't want us participating in their decision making when it came to rules and governance and we didn't care enough to challenge them. We live in fear of the certification exam and the re-certification exam. We live in fear of the certifying authorities and are willing to spend thousands of dollars to be compliant. I don't know of any profession that takes as many exams as we do - SAT, SAT-II, MCAT, USMLE I, II, III, Board Certification, BLS, ACLS etc.

What we have to recognize is that we are a business or we are part of somebody's business model. If we as a group can't get our act together, we will be cast aside. We need to evolve and adapt otherwise we will become the next fad - ie: Blockbuster video. Ten years ago, nobody thought that NPs would come this far. Now they are lobbying to practice independently. We need to force our societies and certifying authorities to evolve and adapt along with us. Otherwise, the more realistic clinical groups (ie: APNs) will surpass us rather quickly.

Déjà vu.....this is why the previous post says we let the ABIM and ABMS get away with this.

An article published in the year 2000 in ACP-ASIM.....

"As the final exam approaches, however, complaints about recertification's inconvenience and irrelevance are giving way to new anxieties. Some internists fear that they will be among the 10% of test-takers who are expected to fail the final exam on their first try. That could hurt their practices, their careers and possibly their patients, who may find their doctor being temporarily dropped from their health plan. (The next exam for internal medicine is not offered until May 2001.)

Individual internists aren't the only ones facing problems. With some subspecialists deciding not to recertify in internal medicine, some hospitals are already anticipating disruptions in their call coverage and attending schedules.

The College has formed a task force to take members' concerns to the ABIM--and to voice objections of its own. ACP­ASIM officials say that the ABIM's recent revisions to the recertification process seem to stray far from the board's role of evaluation and into the College's domain of education. It is just one more concern that has emerged as internists embark on a new, career-long relationship with the internal medicine board."

Go here for the full article: http://www.acpinternist.org/archives/2000/11/recertification.htm

We should have been more active. But hindsight is 20/20. Let's give this battle our best and not give up until they yield!

Kryterion online MOC tests with identity check and K'COPS (KCPs or E-COPS)? Not in my home or office? No thanks. I will not submit to this kind of financial hooliganism and privacy abuse from any medical board. No more! The ABIM and ABMS has gone way too far too many times. Nobody can trust any of their egregiously conflicted executives or alleged "fraudulent" partners. Learning about the ABIM is like reading an ersatz Steven King novel - maybe a sub-par rip-off of the Shining. It has a loser character in a downward death spiral with an addictive lifestyle (money, power and hubris). And the ABIM's storyline has the same kind of predictable ending - bad. These guys are right over an abyss and ready to fall over the edge at any moment. I'm not going down with them. No phoenix will rise from their burnt-out ashes. I'm not sticking around for the tragic moment. "The Fall of the Rich Baron" might make a good opera someday, though.

Btw, I just found the lawsuit filed against Kryterion's employee a few years ago. Not only was this employee pinched by them for salary owed, but they screwed the employee for being a whistleblower as far as I can tell. This could have been presented to the SEC because the company was apparently deceiving investors about the security of the system and overall reliability and cheating employee. And because the employee was a female I would say they took advantage of her and tried to intimidate her from taking action and standing up for what is right and what was owed. There are several testing platform/technology patents that David Foster's company filed as well that may be disputed by other companies.

Who uses Kryterion?American Board of Urgent Care Medicine appears to recertify using Kryterion.

"The Urgent Care Medicine Recertification process is an internet-based program, allowing Diplomates the opportunity to take the exam from any computer with internet access.The recertification program includes all of the study/review questions so there is no need to purchase an additional exam review course.* There are four 50-question study blocks each consisting of multiple choice questions and detailed explanations. The exam itself consists of 100 multiple choice test items, with all of the exam questions taken from the study/review blocks.Sixty days prior to your expiration date the ABUCM will send you a letter with all the details and instructions for recertifying.The fee for recertification is $350. Payment is made when registering online for the recertification program.Recertification should be completed within 90 days of expiration. If recertification is completed within 90 days of expiration, there are no additional fees. An additional fee of $100 (payable to the ABUCM) will be applied for any recertification completed up to one year past the date of expiration, then $200 per year (up to four years) past the date of expiration. Certification expired for four or more years requires submitting an application and taking the full certification exam."

Let's see, they are planning to Federalize MOC and incentivize Choosing Wisely. Now they are planning to make a lot of money by subsidizing online proctoring just to spy on us even more. Every click and keystroke we make now goes to the CMS and the insurance companies via the "cloud!"

What does Caveon/Kryterion have to do with physicians beyond a potential platform and spying company delivering and assuring the integrity of the testing process and possibly ABMS' MOC assessment? There may be a conflict of interest that would be too damning for the ABIM and ABMS to utilize Kryterion/Caveon openly at this point because the ABMS has shared employees/personnel in the past and some of the relationships/history may prove to be of a highly controversial/financially conflicted nature.

Who's who in testing and security industry: Relationships between the ABMS and Caveon/Kryterion. This is relevant to physicians and the copyright lawsuits from 2008 to the present. Evidence may have been improperly gathered and manipulated/altered which is very pertinent to these cases. "ABIM v ABR," "ABIM v. von Muller v. ABIM" and "ABIM v. Salas Rushford v. ABIM" and the others.

From ATP Innovations in testing conference, Orlando FL March 2016 we can glean some of the current relationships and past and present security/investigative/legal personnel at ABIM/ABMS/Caveon/Kryterion.

ABIM and Caveon present together at ATP - ABR with Caveon along with other medical boards ABP, ABO, ABA, ABR, and ABFM. They are at a three day conference presenting various talks/workshops at ATP Innovations in Testing 2016.

Fyi, Marc Weinstein with Caveon/Kryterion worked for Ballard Spahr from 2007-2012 and was second lead attorney under Hara Jacobs in ABIM v ABR and in ABIM v Sarah von Muller. Weinstein and Jacobs were instrumental in obtaining the ex-parte writ to seize property from Dr. Arora's home and the home of Anise Kachadourian.

Weinstein worked with Lynn Langdon, Drs. Cassel, Baron, and Holmboe and ABIM's "director of investigations" (working out of the COO's office) who presented with Weinstein at this conference and many past conferences. The ABIM "director of investigations" is most likely one of the spies/secret police who attended Arora's course in NY 2009. In a recent deposition of Dr. Arora this same mystery person's photo (who is an ex-cop) was shown to Dr. Arora for a yay-nay recognition. Hara Jacobs was staring into Dr. Arora's face, making it apparently quite uncomfortable for Dr. Arora to speak freely - from my reading the court transcript.

Did Ms. Jacobs, ABIM's lead counsel intimidate the witness, Dr. Arora? It certainly may have happened that Jacobs was trying to keep Dr. Arora's responses in line with an agreement in the settlement. Was there a gag order in the settlement? Maybe. Dr. Salas Rushford's attorney was trying to ascertain crucial information if the current ABIM "director of investigations"/"Caveon Director of Investigations" was the ABIM spy/employee who attended Dr. Arora's course in 2009. This would have been the "spy/ex-DC cop" who gave evidence claiming that Dr. Arora had stolen copyrighted material and was using it in his courses. Dr. Arora denied this allegation during the deposition. Salas Rushford called this spy/secret police to give a deposition also, but has not responded to the summons as far as I know.

So the ABIM is in cahoots with a new Spy Cam testing agency? Ties to the Ballard Spahr law firm? Chummy business relationships where everyone makes money off the testing fees? Totally not surprised.

Why would the ABIM be honest and come clean about its dirty operational strategy? Dirtbags.

The future of education including medical education, initial and continuing, is being upended by SoMe, Smart Phones and the Internet. Medical education is a long and convoluted apprenticeship as a part of a guild saturated with brokers all claiming to possess some unique license to exist. For the most part, the transfer of knowledge is largely done person to person. Testing of the fund of knowledge is done in a variety of ways- in person and in person on paper/pencil. This entire process- USMLE, MCAT, ABIM, CME is massive industry larger than many Fortune 500 companies in the aggregate. The money involved here and the power is truly massive.

Along comes the Internet. Along comes SoMe, Smart Phones and Generation X/Millennials. They don't like centralized power involving convoluted human interactions like the ABIM. They enjoy the liberty of e-Interaction and they are quite good at it. Think of all things now e-transformed. Travel agencies, ATMs, hotel reservations, books, mail/communication, hailing a taxi. Has anyone used the Uber app? The world is eliminating unnecessary middlemen and brokers.

In 2008 Salman Khan starts to use the Internet to revolutionize the field of education.

https://www.youtube.com/watch?v=zxJgPHM5NYI

Anyone with a small child trying to learn math and has used his totally free website, www.khanacademy.org, will recognize the power of well designed Internet based tools to augment and accelerate learning at a comfortable, non confrontational manner. Well guess what? Medicine and all of its complex human-human transfer of knowledge with every step of the way involving some transfer of money is being ripped apart by those of us who see the inefficiency of this Old World model. More so when corrupt, dirty bureaucrats like Rich Baron and Harlan Krumholz march around Philadelphia take advantage of a docile cohort entrained to blindly follow the "leader".

For those of you scoffing at this notion, has anyone used UptoDate? How about an app to calculate risk or to find the dose of a drug? What's more efficient- learning at your own pace on a computer or being strip searched at PearsonVue and taking a test under the gun by the ABIM?

Who needs travel agents when you have Kayak?Who needs a bank teller when you have a Wells Fargo app?Who needs a taxi dispatcher when you have Uber?Who needs a map when you have Google Map on your iPhone?Who needs movie theaters when you have Netflix on a laptop?Who needs the USPS when you can email or text?

So who needs the ABIM MOC when you can learn on your own, at your own pace without being ripped off by Rich Baron?

ABIM and the Old World Medical education experience has been about monetizing and manipulating what should be open source material for all physicians to use to augment their fund of knowledge. It is utterly obnoxious that ABIM fees and MOC fees are used to operationalize an organization who has no shame in really ugly, selfish use of that money for levels of luxury often associated with Drug Lords, Hollywood types, and Wall Street Kingpins. Why is the ABIM and the ABIMF selfishly hoarding their "products" at premium prices and falsely proclaiming only they can provide this transfer of open knowledge and certification? Greed. Pure and simple. Greed for money and the power that comes along with a self-declaration that they own this world of medical education.

Watch this YouTube video from Sal Khan at MIT talking about MOOC.

https://www.youtube.com/watch?v=z9JCpMCQ5qM (Start at 1:04:41)

There is an audience question about the attempts by MOOC providers to try and monetize this activity thereby restricting it. MIT was the first to say no and to embrace the concept that MOOC should be a fundamental free right. The distribution of knowledge broadly and in a variety of mechanisms is the most efficient and fair method.

Think about it. What if there was only 2 gas stations in your town? What would happen? Chaos. Long lines Strife. Loss of liberty and freedom. War.

So why on Earth are we accepting the ABIM or any other entity as the only and sole source of MOC authentication?Why is the distribution of medical knowledge micromanaged, packaged and brokered involving money every step of the way? Why is the authentication process of medical knowledge so costly?Why can't MOC emulate MOOC/KhanAcademy- free, at your own pace, without overbearing corrupt nasty professional blood sucking bureaucrats interfering with the process?

What about Wolters Kluwer's acquisition sprees? From Lippincott to HarperCollins to Little, Brown and Company; to Ovid, to Uptodate, MedKnow and beyond.

We would all agree that medical knowledge should be free. I certainly do. Look at the concerning rise of Wolters Kluwer as a handsome investment vehicle for the rich gobbling up all the medical publishers like Uptodate in 2008. What happened after that? They launched the product in the UK in 2014 and in continental EU one month after. 47% of the shareholders are in the UK with 24% in the US. France, Germany, Spain, Switzerland, Netherlands, the rest of Europe and other hold the rest of the issued shares.

Who are the power brokers in healthcare driving them; and what is the likelihood that corporate and government medicine incentivizes Uptodate to propagandize medicine such as "Choosing Wisely" or just infiltrates the organization to the point that we see a potential retail corruption of medical science. I only say this because I am seeing it in Uptodate already - slowly over the past few years.

Also bear in mind that the ABIM is in the process of conducting a pilot project with Uptodate as THE medical source for open book testing to see if this kind of format could be incorporated into the recertification process; but only as PART of the MOC requirements.

The CEO of Wolters Kluwer is an American (since 2003)although the company is registered in the "Nederland." Ga cijfer!

Interesting points from a "Global Research" article pointing out WK's conflicts of interest with big pharma.

"Most medical journals receive half or more of their income from pharmaceutical company advertising and reprint orders, and dozens of others [journals] are owned by companies like Wolters Kluwer, a medical publisher that also provides marketing services to the pharmaceutical industry.” — Helen Epstein, author of “Flu Warning: Beware the Drug Companies” (http://aaci-india.org/COI/Flu_web_final.pdf) (Dr. Gary G. Kohls, Beware the Drug Companies, How they Deceive Us: “Criticizing Big Pharma” Global Research, February 16, 2015) - See more at: http://realitieswatch.com/25-facts-about-the-pharmaceutical-industry-vaccines-and-anti-vaxers/#sthash.s5IQ7znN.dpuf

I am sorry. But I strongly disagree with some of what u say. Most of us here are very academically achieved and were so before applying to medical school. Medicine is amazingly hard and the knowledge base is enormous. And we have to know a lot of it. No amount of Up-to-Dating is going to substitute for active knowledge as u encounter a problem. U have to have learned an approach already and have huge amounts of known detailed information. My YouTube or iPhone or UTDoL is not gonna help me when I am evaluating for a WBC of 12 when someone is on lithium. I could never go back and look up everything needed to solve the case in a practical fashion. I could never get through an H and P if I had to spend 10 minutes online between even a few of the 100 questions I need to ask. Please don't buy into the argument that medicine is a guild or somehow a highly ritualized learning process. It is not. Real medical knowledge is hard and gets handed down in a rigerous way because that is what is needed. If we ourselves underestimate the difficulty of the job, what's to keep administrators from trying to deskill our profession? I will tell u, the more and more I do this, the more I realize crappy care is easy to provide and that good care is very hard to provide with no shortcuts.

Arbi, your points are well taken but we need to separate clinical wisdom and the role of e-education to liberate ourselves from a cartel of greedy testing administrators. To be a successful physician one needs a good contemporary fund of knowledge, a strong work ethic, a general sense of curiosity, congenial people skills, hand/eye coordination, a healthy dose of neurotic behavior etc etc. It is very difficult and complicated for sure. I agree with you. That's why the process begins with an apprenticeship as part of our guild/profession that is based on personalized guides or mentors (chief residents, fellows, attending, advisors). I agree with you that there is no good version of e-Wisdom or iWisdom v2.5. But our profession or guild or whatever is built on one-on-one transfer of skills and knowledge. Malcolm Gladwell accurately described Medical training as such and Jordan Cohen represented residency as an extension of Medical school. That in essence housestaff are still learning and still students. That's why the IRS in 1998 gave back hundreds of millions of dollars to hospitals as they applied to take back their payroll Federal taxes. If you disagree with that, you do not understand the meaning of a guild and the prior adjudication of such by the IRS, the AAMC and the AMA. Medicine is a glorified guild with all the components of the original medieval definition. I understand your reaction but ultimately you are wrong.Once you get past that critical mass of knowledge and experience, the question is how do you keep it contemporary. There is no reason why the transfer of knowledge should be funneled into one path controlled by a small, closed, opaque, overpaid, corrupt organization like the ABIM. That's ludicrous. That's where e-Education is a part of a healthy and efficient process that dispenses information broadly with less cost and less confinement and less opportunity to allow a trade organization like the ABMS and the ABIM to stick their flag in the hundreds of millions of dollars involved. Have you ever asked yourself why you need to give tens of thousands of dollars to an organization that doesn't care about you and your clinical burden of being a physician just so a faceless bunch of administrators can tell you that you are doing a good job? When was the last time ABIM went before Congress and advocated for clinicians? When was the last time ABIM recognized how impoverished our residents and fellows are and gave them a discount on their fee structure? When was the last time ABIM provided any money for research outside of their organization? When was the last time ABIM donated money, personnel and time to a homeless shelter or an overseas medical missionary?

I wouldn't be too hasty to dismiss e-Education in Medicine. When I look at all our housetaff, they're doing it and getting information in a fairly efficient manner. Why can't we get rid of ABIM MOC, let clinicians have the liberty to choose their mode of continuing education at their pace, without paying a lazy broker massive amounts of money? If a physician wants to tailor his education via a Skype consult with a trusted mentor, subscribe to two journals, use an app to calculate risk of an ACS, and go to a National meeting q2y, why is that not valid? Because it doesn't have an ABIM stamp of approval?

Now if you personally want to give the ABIM bags of money and wait for Grand Rounds next month when some topic will be reviewed and then ignore that there is a universe of data at your fingertips that you can pick and choose, then so be it. You can stand on the street and hail a cab or buy your plane ticket at your corner travel agency or buy your authentication of your medical knowledge through a broker/middleman system of waste fraud and abuse. There are those of us who definitely do not.

We question the value coefficient of ABIM MOC and ask why one system costs $170 every two years, and the other costs $15,000-$30,000 every 10 years?

I would agree that generally medical data should not be monetized and turned into a glorified version of Cliff Notes. The consolidation phenomenon that you are describing with Journals and Publishers is probably an inevitable reflection of our Society in general. Less choice and more Uber-consolidation. It's happening with hospitals, Medical device companies, practice mergers, Big Pharma, and the insurance companies.

If ABIM is trying to broker a deal with ONLY Up to Date and the web cam on my computer, they can just forget it. I will never ever ever ever let anyone use my web cam to hack my computer and spy on me. That's just plain stupid and insane. The ABIM is desperate. Their business model is based on their trademarked questions and monetizing it as an annuity. The Internet is allowing a new universe of data harvesting and sourced information that they clearly cannot and do not control. If I can look up the dose of Vancomycin on a web search for free rather than go through some dumb ABIM MOC on line module for $3200, why would I ever choose to use the ABIM MOC?

You know, it's pretty interesting how defensive the ABIM gets when they are rightfully criticized. Their defense strategy usually starts with a dry regurgitation of their 100+ year history and reputation. What they fail to realize is that past history is irrelevant and useless when it has been documented to have blown money on inappropriate items which have been thoroughly documented on SoMe and on this blog.

In fact, their ability to highlight what the ABIM once was in yesteryear and what is it right now, only serves to accentuate the contrast of what this organization has become. A sad, empty shell of its original mission. And for what? A joyride in a Mercedes and a Pied a tierre in Central City Philly? White cloth service at the Four Seasons? So your ABIM Executive Psychometric Secretary can make the same salary as an Critical Care Physician saving someone's life in a MICU on Thanksgiving Day?

1. They keep the 10 year exam if people "fail" their yearly short tests2. They may not let you retake the short tests if they determine you "fail"3. They make use your webcam to invade your privacy to watch you TAKE the short tests4. If they see you look to the left or right , they can sue you for breaching your promise.5. No mention on pt assessment, voice etc

20% of doctors want to keep the 10 year exam......Really??When is the congress starting to investigate Baron and his friends?? This is starting to look as a House of Cards episodeBaron out now!!People wake up

I'm a radiologist very interested in following these issues and making people aware that they should do all they can to reject MOC and the money that it is.

REMEMBER, colleagues (and you all are because if one Board goes down, they all do, the ABMS is the one "ring that rules them all") that the ABMS was created by the various specialty boards BECAUSE they saw that they could hook one another up more easily that way. Rand Paul outed this a long time ago but because of political hacks and hit job media, they just attacked his character, not the extortion scheme of the Boards with certification and the everchanging rules/goalposts and quest for greater $$$.

If you can't get a state to do anything immediately, support NBPAS, and let's just get this back to structured CME that fits YOUR practice!

Everything else is a waste of time and money, and serves ONLY to enrich these elites.

They all have in their governance and bylaws that the "Board of X specialty" is "voluntary" suggesting that they don't coerce anyone --- but we all know that's effectively far from the truth. Even CMS has rules that show that what these boards do is ALREADY illegal. We need to keep the pressure on

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About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.